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DIVERSIFIED PROFESSIONAL COMPANY NPI 1487736161


NPI Information

NPI: 1487736161
Provider Name: DIVERSIFIED PROFESSIONAL COMPANY

Doing Business As: CANYON VIEW PHARMACY

Classification: Pharmacy - 3336C0004X
Entity Type: Organization

Specialization: Compounding Pharmacy

CLIA Number: 46D0930704

Address:
1159 E 12TH STREET
OGDEN, UT
ZIP 84404
Phone: (801) 334-3190
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DIVERSIFIED PROFESSIONAL COMPANY is a compounding pharmacy pharmacy in Ogden, UT. The provider is a pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. DIVERSIFIED PROFESSIONAL COMPANY NPI is 1487736161. The provider is registered as an organization entity type.
The provider Is Doing Business As Canyon View Pharmacy.

The provider's business location address is:

1159 E 12TH STREET
OGDEN, UT
ZIP 84404-144
Phone: (801) 334-3190
Fax: (801) 334-3193

The provider's authorized official is Gary Lynn Bailey .
The authorized official title is President and has the following contact phone number (801) 334-3190.

The CLIA number assigned to this NPI record is 46D0930704 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 10/20/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0004XPharmacyCompounding PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1870218488006MEDICAIDUTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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